According to the abstract published in the Journal of General Internal Medicine, the researchers used the Double Diamond human-centred design framework, which has four phases: discover, define, develop and deliver. They conducted two co-design workshops with queer older adults and healthcare professionals. Activities included storytelling, identifying barriers and generating solutions. Researchers analyzed transcripts, field notes and participant materials using inductive analysis, then associated codes with phenomena described in earlier literature and renamed them to align with existing terminology. The abstract does not report workshop participant counts, recruitment procedures or detailed measures of representation.

The first theme, relational ontologies, described how queer older adults’ health experiences are shaped by relationships, inclusive language, visibility and recognition of chosen family. The second, institutionalized othering, addressed how heteronormative policies, assumptions and educational gaps can marginalize queer identities and relationships within healthcare systems. The third, self-protective behaviours, captured strategies used by queer older adults to manage disclosure, assess safety and protect themselves from anticipated discrimination. These themes represent the study’s reported analysis rather than measured effects of a training intervention.

The authors said the findings are informing core content areas for an educational toolkit currently in development. Proposed areas include inclusive communication, chosen family and affirming interpersonal care under relational ontologies; structural stigma, heteronormative policy critique and system-level inclusion under institutionalized othering; and disclosure-sensitive practice, trust-building and reducing barriers to safe engagement under self-protective behaviours. They stated that the planned toolkit is grounded in lived experience and design best practices and is intended to enhance healthcare professionals’ preparedness and advance equity in care. Because the published evidence supplied here is limited to the abstract, the study’s full methods, workshop materials, detailed analysis and any limitations beyond the absence of an intervention evaluation cannot be assessed.

Subject of Research: Co-design of healthcare professional education for queer older adult care

Article Title: What Healthcare Professionals Need to Understand About Queer Older Adult Care Experiences: A Double Diamond Design Study

Article References: Hall, S., Code, D., Dyck, D., Rabari, D., & Hubbard Murdoch, N. (2026). What Healthcare Professionals Need to Understand About Queer Older Adult Care Experiences: A Double Diamond Design Study. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-026-10800-0

Image Credits: AI Generated

DOI: 10.1007/s11606-026-10800-0

Keywords: queer older adults, healthcare professionals, educational toolkit, human-centred design, co-design workshops, inclusive care, chosen family, healthcare education, Saskatchewan, qualitative research, Healthcare, Professionals

The research, led by Hayley Leggett of Tohoku University with colleagues at the International Research Institute of Disaster Science, applied human-centred design, a methodology that places the needs, values and lived experiences of end users at the heart of the design process, to the problem of tsunami mitigation under rising seas. The team drew on earlier empirical work in Kesennuma showing that residents value visibility and connection to the sea, want defences that blend with the landscape, prefer alternatives to concrete, and place trust in infrastructure rooted in local identity as much as in perceived safety. Rather than treating these preferences as constraints on engineering, the researchers used them as generative design inputs, producing three conceptual multi-layered defence configurations and then testing each one rigorously through numerical simulation under combined tsunami and sea level rise scenarios.

The three designs represent distinct philosophies. Defence 1, an eco-hybrid system, integrates natural and low-impact solutions: offshore submerged concrete pile arrays with artificial reefs that dissipate wave energy through drag and turbulence while enhancing biodiversity, vegetated berms and bioswales along the coastline that absorb overflow and filter sediment, and elevated evacuation landscapes inland that double as public green space. Defence 2, a discreet integrated barrier system, prioritises openness: low-crest tetrapod fields arranged in staggered grids offshore, glass-composite seawalls with automated hydraulic floodgates that sit flush with the ground under normal conditions and rise automatically during tsunami alerts, and rooftop safe zones with elevated pedestrian pathways inland. Defence 3, a reinforced high-performance system, is the engineering-led benchmark, combining reinforced concrete pile fields at the harbour entrance, stepped seawalls of five to seven metres paired with buffer parks that temporarily store overtopping water, and floodable retention areas providing secondary containment.

To evaluate these configurations, the team employed TUNAMI-N2, a two-dimensional nonlinear shallow-water model that solves the depth-averaged nonlinear shallow-water equations for incompressible flow under the hydrostatic assumption. The model conserves mass and momentum, represents bottom friction through spatially varying Manning’s roughness coefficients, and was solved using a staggered leap-frog finite-difference scheme with second-order accuracy in space and time. A six-layer nested grid system resolved tsunami dynamics from regional propagation at 1,215-metre resolution down to 5-metre grids covering Central Kesennuma and Kesennuma Bay, capturing urban streets, river mouths and ports where run-up and inundation actually occur. A uniform one-second time step satisfied the Courant-Friedrichs-Lewy stability condition in the finest domain. TUNAMI-N2 has been extensively validated against observed data from the 2011 Tohoku tsunami along the Sanriku coast and the 2004 Indian Ocean tsunami, giving the comparative results a solid empirical foundation.

The simulation campaign was exhaustive: 150 runs covering all combinations of two study areas, three tsunami sources drawn from the Kuril Trench, the Japan Trench and the 2011 Tohoku event, five defence states including no defences and the current post-2011 infrastructure, and five sea level rise conditions. Those future scenarios came from the NASA Sea Level Projection Tool at the Ofunato II reference location, with increments of +0.40 metres by 2050 and +0.97 metres by 2100 under the intermediate SSP2-4.5 pathway, and +0.44 and +1.28 metres under the high-emissions SSP5-8.5 pathway. Each simulation produced inundation extent, fatality estimates based on depth-dependent empirical rates applied to census population data, and economic losses calculated per building using depth-damage functions and a conservative 20-million-yen replacement proxy.

The results revealed a consistent and, for advocates of human-centred design, remarkable hierarchy. Defence 3 achieved the strongest containment across every metric, as expected for the most structurally dominant configuration. But Defence 2, the transparent, open-feeling barrier system that most closely aligns with residents’ preferences for visibility and waterfront access, delivered reductions typically within 10 to 15 percent of Defence 3 across inundation extent, fatality rates and economic loss. Defence 1, the eco-hybrid, provided only limited hazard reduction, allowing broader and shallower flooding as its vegetated berms and bioswales were overtopped, and proved unsuitable as a standalone mitigation system. The ranking held across all three tsunami sources and all sea level scenarios, confirming that defence configuration and continuity, rather than sea level alone, are the principal determinants of protective performance.

Sea level rise acted primarily as an amplifier rather than a ranking-changer. Higher baseline water levels produced deeper and more extensive flooding, with isolated shallow zones merging into continuous inundation belts along the waterfront by 2100 under high emissions, particularly along inner bay margins, river corridors and reclaimed land. Yet the relative performance of the defences remained stable, and in fact Defence 2 and Defence 3 continued to improve relative to the no-defence baseline as sea levels rose, while Defence 1’s advantage fell sharply under late-century conditions. The authors stress that fatality figures are comparative indicators within a controlled framework, not predictions of real-world casualties, since evacuation behaviour, warning status, time of day and demographics all influence actual mortality but fall outside a deterministic depth-based model.

The findings carry weight because Kesennuma is not a blank slate. After 2011, the city invited public participation in reconstruction planning, unlike many neighbouring municipalities, and residents’ input produced real modifications: lowered seawall heights in certain areas, reinforced glass windows along the port seawall, and hydraulically operated barriers that rise with water ingress to preserve sightlines. Some regional media and neighbouring municipalities criticised this participatory stance as overly individualistic, arguing that negotiated reductions in defence height compromised protection. The new modelling offers a quantitative rebuttal to that criticism, demonstrating that openness and access need not come at a meaningful cost in safety when the design is engineered deliberately around those values from the start.

The study also highlights a sobering nuance: physical defences reduce economic loss far more directly than loss of life. The largest inundation reductions occurred in the port district and industrial areas where few residents live, so fatality reductions against the no-defence baseline were comparatively modest, consistent with evidence that hard structural measures are less effective at saving lives than at reducing physical damage. This suggests that closing the life-safety gap may depend as much on evacuation planning, early warning and education as on taller walls, and the authors note their framework cannot yet adjudicate between those routes.

The researchers are careful about limitations. The configurations are conceptual analytical prototypes, not construction plans; mechanical feasibility, constructability and long-term maintenance were not empirically tested, and vegetation effects were represented through surface roughness rather than stem-scale drag. The deterministic three-source approach reflects Kesennuma’s official hazard framework but does not capture the full variability a probabilistic assessment would provide, and larger or differently oriented megathrust sources could produce longer waves and longer overtopping durations that stress the defences in unmodelled ways. Future work should incorporate probabilistic modelling, cross-hazard analysis including storm surge, physical wave-tank validation, and presentation of the designs back to residents to test social acceptability. Still, the central message is striking: a transparent, socially integrated tsunami defence achieved nearly the same protection as towering concrete walls, offering coastal cities worldwide evidence that safety and human-centred design can genuinely coexist as sea levels climb.

Subject of Research: Human-centred design of multi-layered tsunami defences evaluated under sea level rise scenarios in Kesennuma, Japan

Article Title: Human-centred design approaches to tsunami mitigation under sea level rise in Kesennuma, Japan

Article References: Leggett, H., Al Farizi, M. D., Purnama, M. R., Suppasri, A., & Imamura, F. (2026). Human-centred design approaches to tsunami mitigation under sea level rise in Kesennuma, Japan. Natural Hazards and Earth System Sciences, 26(10), 4911-4935. https://doi.org/10.5194/nhess-26-4911-2026

Image Credits: AI Generated

DOI: 10.5194/nhess-26-4911-2026

Keywords: tsunami mitigation, sea level rise, human-centred design, Kesennuma, coastal engineering, TUNAMI-N2, multi-layered defence, Japan, disaster risk reduction, numerical modelling, seawalls, community resilience

The research team, led by Chaojin Da of Shandong University and corresponding authors Shousi Lu and Shicai Wu, worked in Gansu Province, a region of relatively low socioeconomic development where two counties operate under the same national screening programme but differ sharply in ethnic composition. Dongxiang County is concentrated among the Dongxiang, an ethnic minority group with its own language, while Lintao County is predominantly Han Chinese. By comparing these two geographically close sites, the researchers could ask a deceptively simple question with major policy implications: do the same obstacles matter equally everywhere, or must screening services be tailored to local cultural and social realities?

Methodologically, the study drew on human-centred design, an approach that places the lived experiences of users at the centre of service improvement. In the first phase, the team conducted semi-structured interviews with 103 participants drawn from five stakeholder groups, including women eligible for screening, health workers, and local administrators. Thematic analysis of these interviews identified fourteen distinct barrier themes and eleven facilitator themes. Crucially, the researchers then mapped every theme onto a matrix combining the socio-ecological model, which spans individual, interpersonal, community, organisational, and policy levels, with three stages of the screening journey: pre-screening, screening itself, and post-screening follow-up.

This mapping produced a pattern that the authors describe as central to their conclusions. Most barriers and facilitators were concentrated in the pre-screening stage, the period before a woman ever reaches a clinic, when awareness, beliefs, and logistics determine whether screening happens at all. Four barrier themes and six facilitator themes spanned at least two stages of the journey, suggesting that some forces, such as fear of results or poor communication, echo across the entire process rather than confining themselves to a single moment. For programme designers, the implication is clear: interventions that only address the clinic visit itself will miss the majority of the friction points.

When the researchers ranked the barriers at each site, one theme towered above the rest at both Dongxiang and Lintao: suboptimal education and information delivery. Women in both counties reported insufficient or unclear information about why screening matters, what the tests involve, and what to do afterwards. Alongside this shared top barrier, bodily and privacy concerns and screening beliefs and cognitive biases also ranked highly at both sites, reflecting anxieties about exposure, embarrassment, and fatalistic or mistaken ideas about cancer that suppress participation even when services are free and nearby.

Beyond these commonalities, the two counties diverged in ways that argue strongly against one-size-fits-all policy. In Han-majority Lintao, barriers relating to on-site service and workflow, time–role conflict between screening and work or family duties, and result-related fears that drive screening avoidance ranked higher. In minority-concentrated Dongxiang, by contrast, gaps in result communication and follow-up support, along with non-adherence to recommended follow-up care, ranked higher. In other words, the Han-majority site struggled more with getting women through the door efficiently, while the minority-concentrated site struggled more with closing the loop after abnormal findings, a distinction that could mean the difference between early treatment and late presentation.

The second phase of the study brought these findings back to the communities through participatory stakeholder workshops, one in Dongxiang with sixteen participants and one in Lintao with eleven. Using individual ratings followed by group discussion, stakeholders prioritised the identified barriers and twenty-eight service-improvement suggestions generated in phase one. This participatory design matters scientifically as well as ethically: it converts qualitative barriers into locally validated priorities, giving health planners a ranked agenda rather than a laundry list.

Some improvement suggestions commanded broad agreement. Off-peak scheduling, so that women are not forced to choose between harvesting fields or caring for children and attending a screening appointment, ranked highly at both sites, as did clear explanation of screening results. But the top-ranked concrete interventions differed revealingly. In Dongxiang, mobile screening vans that travel to villages took first place, addressing distance and transport barriers in a dispersed, mountainous, minority-language setting. In Lintao, free add-on tests took the top spot, suggesting that in the Han-majority county the perceived value of attending could be raised by bundling additional health checks into the visit.

The deeper structural insight of the study lies in the alignment, or misalignment, between where barriers occur and where solutions can act. Barriers clustered at the individual level, such as fear, beliefs, and limited knowledge, and at the interpersonal level, such as family dynamics and social norms. Yet the corresponding service-improvement themes concentrated at the community and organisational levels, including outreach, scheduling, mobile services, and workflow redesign. This asymmetry is not a flaw but a roadmap: it implies that individual-level hesitations are best shifted not by lecturing women one by one, but by reshaping the community and institutional environment around them, with policy support sustaining the whole effort.

The authors conclude that improving screening participation and continuity requires particular attention to pre-screening barriers while maintaining support across the entire journey, and that service improvements should be adapted to local contexts rather than imposed uniformly. For a country pursuing nationwide cancer early-detection goals, and for global programmes serving rural, multi-ethnic populations elsewhere, the study offers a replicable template: map barriers across the full screening journey and every socio-ecological level, then let local stakeholders rank the fixes. The result is a screening programme designed not for women in the abstract, but for the specific women, villages, and clinics where cancer either is caught early or is not.

Subject of Research: Barriers and facilitators to breast and cervical cancer screening in rural multi-ethnic northwestern China

Article Title: Barriers, facilitators, and prioritised service-improvement suggestions across the breast and cervical cancer screening journey: a two-phase exploratory study in rural multi-ethnic northwestern China

Article References: Da, C., Huang, Y., He, W., Han, Y., Ma, X., Wang, S., Ji, Z., Gao, X., Zhang, W., Wu, Y., Lu, S., & Wu, S. (2026). Barriers, facilitators, and prioritised service-improvement suggestions across the breast and cervical cancer screening journey: a two-phase exploratory study in rural multi-ethnic northwestern China. BMC Public Health. https://doi.org/10.1186/s12889-026-29625-x

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29625-x

Keywords: cancer screening, breast cancer, cervical cancer, rural China, ethnic minorities, socio-ecological model, human-centred design, participatory research, health services, Gansu Province, screening barriers, public health